California Options Counseling Draft Standards
December 2012

Introduction

According to the Administration for Community (ACL), the primary goals of Options Counseling (OC) are to facilitate informed decision-making about Long-Term Services and Supports (LTSS) and serve a key role in the streamlined access to supports. It represents a critical service of Aging and Disability Resource Centers (ADRCs) as they help provide a clear pathway for individuals to access LTSS. It supports the broader system goals of rebalancing Long-Term Services and Supports (LTSS) and helps to prevent or delay premature institutionalization by offering options to help individuals spend resources wisely in the community. Beginning in 2011, with funding from a federal 2010 Options Counseling grant, California assembled an Options Counseling Workgroup (WG) to provide input on the development of Options Counseling Draft Standards for use in California. The WG met regularly and using national draft standards as a framework, released the California Draft Options Counseling Standards in December, 2011. Between January and June, 2012 the Standards were tested in seven locations throughout the state. In October, 2012, the WG was reassembled to further refine the Standards for use in California based on pilot results and evaluation findings. As national guidance around Options Counseling continues, the WG will refine the Options Counseling Draft Standards to best suit the needs of California residents.

Goals of the Standards

Consistent with federal goals, the main goal of these following standards is to provide a clear definition of Options Counseling and a framework for which the aging and disability organizations involved in ADRC networks can build Options Counseling capacity. The specific goals of these standards include:

Improving the consistency and quality of Options Counseling provided by ADRC networks including capacity to work with individuals who have private resources to spend on LTSS as well as those who may qualify for publically funded programs;

Developing the groundwork for training and continuing education materials and programs related to Options Counseling; and

Preparing the aging and disability networks to meet the demands of the next several decades as a growing aging and disability population base seeks assistance in navigating LTSS.

ADRC Options Counseling is an interactive process where individuals receive guidance in their deliberations to make informed choices about long-term supports. The process is directed by the individual and may include others that the person chooses or those that are legally authorized to make decisions on behalf of the individual who needs long-term services and supports (LTSS).

Guidance

Options Counseling includes the following steps:

Personal Interview: to focus on strengths, values, and preferences for the types of LTSS. The interview may also include screening questions that indicate eligibility and need for public programs;

Decision Support: to facilitate informed decisions and explore resources and service options and to support the individual in weighing pros and cons of each decision;

Action Plan Development: specifics set by the consumer to work toward a goal or a long term support plan; including assistance in applying for direct support services when requested; and

Follow-up: to assess the quality of the Options Counseling service and ensure connections to supports based on decisions made by the individual.

If the local Options Counseling service does not include “hands on” assistance with applications for services, employment assistance, benefits counseling, futures planning, mobility assistance, skills training and/or support accessing participant-directed services, the Options Counselor connects the individual to someone who can provide support in these areas.

Options Counseling is available to all persons with a disability, older adults or caregivers who request or require LTSS for a current and/or future long-term need; including, persons with any level or source of income.

Guidance

While outreach to the broader service population is the ideal, if Options Counseling sponsoring organizations have limited resources, the service may be targeted using the following priorities due to consumers’ urgent need for information and services:

ADRCs strive to use the latest research and data available to identify the populations that might benefit the most from Options Counseling. The Options Counseling service responds to needs of the community as identified in local processes.

Caregivers: In some cases, caregivers may be the individuals seeking assistance with decision-making. Options Counseling is offered to caregivers to assist in determining their desire for caregiver support which might include: communication strategies, ways to reduce caregiver stress, and the importance of individual self-determination. It is essential to support caregivers, while at the same time, protecting the rights of individuals to privacy and self-determination. The ADRC partners can tap various resources for supporting caregivers, including options counseling, to connect individuals to the supports and services they desire in a seamless and unified way. A core tenant of an ADRC and the Options Counseling service is a commitment to break down barriers to assistance and support from multiple organizations and service networks.

Standard 1.3: Marketing/Outreach

Each ADRC partnership includes Options Counseling in its overall marketing plan to promote awareness of Options Counseling to individuals and community providers.

Guidance

See California’s ADRC Designation Criteria for more information about joint marketing plan requirements.

Standard 2 - Getting to Options Counseling

Standard 2.1: Initiation/Referral Protocols for Options Counseling

Each ADRC partnership has shared protocols for receiving and handling initial inquiries/referrals that lead consumers to the initiation of the Options Counseling service. ADRC partnership organizations work together and have agreed upon a uniform process and criteria that triggers referrals for Options Counseling.

Guidance

ADRC partner organizations can conduct an inventory of where consumers seek LTSS information, what technical intake tools are used and what staffing is used for program/service intake across partner organizations. Partners then can develop a shared protocol and training for staff who are in the best situation to refer consumers to the Options Counselors (e.g., Information and Referral/Assistance (I& R/A) specialists, 211 specialists, Health Insurance Counseling and Advocacy Program (HICAP) counselors, benefits counselors, Department of Rehabilitation counselors, and others as identified).

ADRCs work with extended partner organizations so that the shared Options Counseling referral process is utilized at all locations where the Options Counseling is offered. The shared Options Counseling Protocol describes the number and locations of Options Counselors and the criteria used to refer people to Options Counseling. The Options Counseling Protocol identifies uniform forms, tools or other technical tools used by Options Counselors. Over time, these tools and protocols can evolve as the ADRC partners make additional LTSS system changes.

Some situations or scenarios that may indicate a need for Options Counseling include when an individual:

requests or indicates an interest in receiving information or advice concerning long-term support options;

has multiple problems and service needs, expresses challenges seeking, organizing, and following through on service options;

is referred to the ADRC by a hospital, nursing home, assisted living home (or other long-term residential setting), home and community based waiver services provider, or other agency (including Minimum Data Set (MDS) 3.0 Section Q and Money Follows the Person (MFP) referrals;

has had recent change in life situation and desires deeper discussion about their options;

has LTSS needs but unsure about the process of accessing services or what services will best meet their preferences and needs;

is requesting assistance in transitioning from one living situation to another;

might be eligible for new benefits and supports and is unsure of what is best for them or what they might be eligible for;

is interested in a participant-directed program or decision support assistance;

is admitted to the hospital and needs to know what they should be planning for once discharged;

was denied eligibility for Medi-Cal or another public program (including In Home Supportive Services (IHSS), CalFresh, Supplemental Security Income (SSI) or other program) and needs decision support about other options;

lacks awareness of existing community resources and supports and could benefit from decision support and education around their options;

has cognitive impairment and could benefit from support about early intervention, caregiver support, or LTSS related to dementia;

has behavioral health needs and would like support on options related to their specific needs or situation; or

has multiple needs or a chronic illness and has a need or desire for support on a broad array of options to meet their needs across many services and systems.

Options Counseling may also be appropriate in the case of family members and/or caregivers planning LTSS for a loved one. Even in caregiver or family member situations, the focus is on informed decision making by the person who needs the LTSS services. Options Counselors are trained and experienced in tactfully preserving the rights and privacy of the person needing LTSS. Options Counselors may provide the Options Counseling service when there is a surrogate decision-maker, e.g., Power of Attorney for Health Care.

Standard 2.2: Delivery Setting/Model

Options Counseling is delivered in the setting and by the method desired by the individual.

Guidance

Although the goal of the standard is to provide Options Counseling in a method desired by the individual, it is understood that while Options Counseling agencies should strive to provide Options Counseling in a variety of settings, organizations may have resource and location constraints that may need to be considered. Settings for Options Counseling may include the individual’s place of residence, an agency office, a nursing home, hospital, rehabilitation center, medical practice, or even non-traditional settings of the individual’s choosing.

Options Counseling discussions are private and may touch on personal matters that require trust in the Options Counselor. Opportunities for face-to-face meetings should be available to consumers who request Options Counseling. When face-to-face meetings are not possible or are not requested, telephone, email, teleconference and video-conferencing are also acceptable modes of Options Counseling service delivery. The ADRC may wish to establish guidance for staff on when to offer an in-person meeting or home visit.

Standard 3 - Components of Options Counseling

Standard 3.1 Personal Interview

A key component of effective Options Counseling is setting a welcoming tone through a person-centered dialogue to learn about the individual’s values, strengths, preferences, and concerns.

Guidance

Motivational Interviewing and active listening are key skills of the Options Counselors. This discussion is a process of discovering factors important to assist the person in exploring options and developing an action plan. It is important that the individual has to “tell their story” only once and is not burdened by multiple invasive interviews asking the same questions about his/her needs for LTSS. Pertinent information obtained through the interview need to be recorded by the person performing Options Counseling and shared only with the individual’s consent. The individual may choose to have a family member, caregiver, support person, or advocate participate with them during the interview.

This conversation may occur once or over a series of interactions.

The conversation should touch on key areas that would influence available options relevant to the individual’s situation including strengths, physical, emotional, social, financial, and functional aspects. The Options Counselor may need to obtain specific, pertinent information to assist in the application for publically funded services and supports and should obtain the necessary releases of information to share information.

The conversation should occur in a timely manner and meet the schedule and needs of the individual.

Options Counseling is person-centered and the individual controls the planning process, which includes: selection of goals; when and where meetings are held; who is a part of the planning meetings; the topics to be/not to be discussed; and personal decisions about supports and services.

The communication needs of the consumer must be met in order for Options Counseling to be effective. For example, consumers who are deaf or hard of hearing and use sign language to communicate should be provided interpreter service as opposed to being required to struggle with lip reading. Language competency further enhances the Options Counseling service.

Standard 3.2: Exploring Options/Planning

Options Counseling includes the exploration of all options so a person can choose what is right for him/her. Options Counseling assists a person in developing an action plan based on the individual’s own preference, choice and responsibility.

Guidance

Options Counseling is a ‘do with’ and not a ‘do for’ service. Options Counseling is designed to assist an individual with determining and directing his/her personal long term care needs or future long term services and supports. Options Counseling encourages the consumer to develop an action plan for achieving a goal that is meaningful relative to living with chronic condition(s) and/or disability. Options Counseling involves a discussion of the various resources available based on a person’s individual need. Resources may include informal support, privately funded services, publically funded services, skills building supports and benefits information, and any number of other resources and topics of information. The Options Counselor supplements his/her own technical knowledge with access to a wide network of other resource and program specialists.

For those individuals needing assistance urgently (presence of imminent risk to health and safety or suspected abuse), ADRCs have shared protocols for Short Term Service Coordination (STSC) and/or protocols for warm (immediate telephone referral) transfers to an ADRC partner that can provide the STSC service. Additional features of keeping the Options Counseling session focused include:

Options Counseling includes a discussion of available options across multiple programs and services without the personal bias of the Options Counselor.

Organizations providing Options Counseling have policies and procedures in place to remain free of conflicts of interest. As part of the Options Counseling process, the options counselor will encourage the individual to explore informal supports that might be available such as support from community groups, places of worship, neighbors, and friends.

The Options Counseling process will include discussion of publically funded LTSS as well as private LTSS including the approximate cost of services.

Options Counselors facilitate futures planning by talking with individuals about options for services and supports should they be needed in the future.

To assist in the exploration of available options, it is recommended that Options Counselors assist individuals, when necessary, in making appropriate connections to persons that have specific training in available benefits and expertise related to the persons options (such as HICAP counselors, financial, employment, mobility assistance, etc.).

Standard 3.3: Decision Support

In addition to discussing and sharing information about available resources, Options Counseling assists the person in evaluating various pathways, including the pros/cons of specific options. Options Counseling leads to informed personal decisions and choices.

Guidance

Decision support is best performed by utilizing specific decision support tools, decision support processes, and decision support techniques, such as motivational interviewing and person-centered planning, and other person-centered tools.

Standard 3.4: Options Counselors facilitate development of an Action Plan or other long term support plan.

Guidance

The written Action Plan serves as a guide for the individual who discusses with the Options Counselor the steps necessary to achieve goals or obtain LTSS and maintain independence that is important to him/her. The plan may include “to do’s” for both the Options Counselor and the consumer and may lead to additional, more in depth discussions of certain options.

It is important for the plan to be shared by the individual with others as desired, as well as retained in a file or electronically by the Options Counselor to use for follow-up and quality actions.

Standard 3.5: Access to Community Supports

In addition to decision support, Options Counselors provide assistance as requested by the individual to apply for and gain access to specific services and supports.

Guidance

This support could be a short or long process depending on the direction from the individual, degree of urgency expressed by the individual in meeting his or her goals, or availability of funding to provide such support. If this function is not performed directly by the Options Counselor, the ADRC will have appropriate referral protocols in place to support individuals in accessing this support from other sources. Options Counseling is part of a uniform process across the state that can streamline eligibility and access to public programs. Each local area will streamline these functions in ways that are unique to the local programs and service provider networks. Connection to community supports may include the following components:

providing or coordinating eligibility determination;

assisting as services and supports are arranged/scheduled; and/or

accessing resources in order to return to the community from an institution or hospital (e.g. transition coaching).

The ADRC network’s capacity to provide on-going support to individuals may vary depending on availability of funding to support Options Counseling. ADRCs may want to develop this capacity to take advantage of a broad range of funding sources that support independent living in the community.

Standard 3.6: Follow-up

Follow-up is an essential component of Options Counseling.

Guidance

Follow-up allows the Options Counselor to learn from the individual what progress towards goals and steps in the action plan has occurred. Any barriers to implementing the action plan can be discussed and the Options Counselor and individual can strategize about alternatives. Organizations offering Options Counseling should have standards for follow-up including time-frames, methods and activities that can monitor the quality of the Options Counseling service. Guidelines for follow-up include:

May be conducted in person, by phone, or electronically as resources allow and the individual prefers.

While, the individual’s action plan should guide the time-frame for follow-up, following up one month after Options Counseling process is a general guideline.

Provides the opportunity for the individual to clarify questions concerning his or her plan.

Provides the opportunity for the individual to receive assistance from the Options Counselor regarding the application and eligibility processes, if requested.

Provides the opportunity for the Options Counselor to provide further information or clarity surrounding action steps.

Lets the individual request assistance regarding the implementation of LTSS.

Allows the individual and the ADRC to evaluate the usefulness of the service, such as barriers encountered in achieving his or her goal, service gaps or whether the goals were met.

Standard 4 - Staffing

Standard 4.1: Staffing Structure

The Options Counseling service is provided by any partner organization within the framework of an ADRC partnership.

Guidance

Options Counseling is provided to one individual by one Options Counselor who supports the individual through the entire decision making process and follows up with the individual to see what decisions are working.

Rapport-building is a critical component of Options Counseling.

It is recommended that ADRCs consider training existing staff from various departments and programs such as I & R/A, peer counselors, service coordinators, independent living skills trainers, case managers, front-line staff, transition coaches, or support brokers for participant-directed programs, as examples.

ADRCs may choose to have Options Counselors provide Options Counseling as their only job responsibility, or ADRCs may organize their staffing structure that optimizes existing staff who serve in “blended roles” within the ADRC. It is at the discretion of the ADRC to determine what staffing structure will work best based upon their agency, organizational capacity and target population.

The role of the Options Counselor and specialized skill set they bring in facilitating decision support may be valuable to other LTSS programs and initiatives. ADRCs may choose to organize their staffing structure in a way that builds the core competencies of their Options Counselors to support these other initiatives, or to hire specialized staff who are trained in Options Counseling but work only in their role as a care transition coach, or a MFP transition coordinator. It is up to the ADRC to determine what capacity they have to meet the needs of their consumers and the programs they have responsibility for administering.

Additional federal guidance on staffing the Options Counseling service is expected in the future.

Given the complexity of the work and the level of skill needed, it should be noted that Options Counseling is not an entry level position. Experience with the listed competency domains should be strongly considered.

Additional federal guidance on Options Counseling staff competencies is expected in the future.

The Administration for Community Living is actively working to develop a national Options Counseling curriculum and training program. Until this national certification training and process is complete, Options Counseling training will be conducted by the State. The State training is consistent with the nationally recommended training topics.

Each ADRC is encouraged to having an ongoing staff development program in place.

It is recommended that persons performing Options Counseling receive ongoing training in the following areas:

Physical and emotional aspects of aging and disability,

Medical model vs. Social Model of aging and disability,

Different models of adjustment to disability,

Working with individuals with cognitive impairments and their caregivers,

Additional federal guidance is expected in the future. In the interim, Options Counseling supervisors should possess the experience or educational training to oversee staff development, program management, program planning, policy/procedural maintenance, and program evaluation. Generally, a bachelor’s degree in a human services related field would be minimum qualifications plus three – five years of direct service and/or management experience. A master’s degree may be preferred. States and localities may consider the replacement of experience and training for the degree requirement.